Magnesium in Menstrual Migraines
Source: Mauskop A, et al. Headache. 2002;42:242-248.
In this prospective study, 270 women seen at a headache clinic, including 61 patients with menstrual migraine, had measurements of serum ionized magnesium (IMg) levels and serum ionized calcium/ionized magnesium ratios (ICa/IMg). The incidences of IMg deficiency were 45% during menstrual migraines, 15% during nonmenstrual attacks, and 14% during menstruation without migraine (P < 0.01). Similarly, the ICa/IMg ratios were elevated during menstrual migraine (P < 0.01).
Commentary
In some series the incidence of menstrual migraines is 24%, and their management is often difficult. The decline in estrogen occurring before menstruation has been implicated as a precipitating factor, although benefits of hormonal manipulation with agents like danazol or tamoxifen are unclear. Magnesium supplementation for prophylaxis in menstrual migraine has met with some success. In this study by Mauskop and colleagues, low levels of serum IMg seem to be associated with menstrual migraines, although causal etiology and pathogenesis have not been defined. Possibly, subtle derangements in levels of these divalent cations directly affects cerebrovascular constriction or neurotransmitter release. —Brian R. Apatoff
Dr. Apatoff, Associate Professor of Neurology, New York Presbyterian Hospital-Cornell Campus, is Assistant Editor of Neurology Alert.
Sudden Death in Epilepsy
Source: Pedley TA, Hauser WA. Lancet. 2002;359:1790-1791.
Following a first introductory paragraph directed at the recent literature’s sudden unexplained death in epilepsy (SUDEP), Pedley and Hauser turned to the report of the United Kingdom’s charitable group called Epilepsy Bereaved.
A study was released on May 20 entitled "Epilepsy—death in the shadows: Report of the national sentinel clinical audit of epilepsy-related death." The study surveyed cases in which epilepsy was listed as the primary cause of death. Over 1 year, 2412 death certificates met this criterion, of which 1023 patients underwent post-mortem examination. Forty percent of the latter cases (as well as 10% of cases that were not autopsied) were further analyzed with respect to the medical care received prior to death.
Medical care was grossly poor as highlighted by the following findings. Thirty-seven percent of adults had not seen a physician in the year preceding death. While few patients were seizure-free, 7% were not taking any antiepileptic drugs at the time of death. The study concludes that "poor epilepsy management results in a substantial number of potentially avoidable deaths."
Commentary
As many as 18% of all deaths in epilepsy patients have been attributed to SUDEP. Continued seizures despite treatment are also a major risk factor for SUDEP. It stands to reason that deficient therapeutic management documented by the UK audit contributes to avoidable cases of SUDEP. Most alarming is the fact that these patients were deprived of standard medical management, rather than this being a cohort of medically refractory epilepsy patients. We hope our neurological readers pay attention to this article in their communities.
The complete text of the audit can be reviewed at: http://dspace.dial.pipex.com/epilepsybereaved/audit/audit.htm. —Andy Dean
Dr. Dean is Assistant Professor of Neurology and Neuroscience, Director of the Epilepsy Monitoring Unit, Department of Neurology, New York Presbyterian Hospital—Cornell Campus.
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